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z <br /> Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator g 3 SIJ <br /> APPLICATION FOR LAND USE PERMITS <br /> ^ J <br /> OWNER r a <br /> '� �114- 5 � /�(Z-SON /71 - 2sE�y TELEPHONE <br /> 4s� .f <br /> MAILING ADDRESS <br /> )Q/l.7c S-f, ecJ,31— p-, N /U .. <br /> i <br /> PROPERTY ADDRESS .2 y,/-2 ?3 m z .e f7d _ �Ct ra 1,9a" c �Q <br /> LEGAL DESCRIPTION (J <br /> , p Tyolv -p j–IL o <br /> TYPE OF PERMIT(S); SINGLE-FAMILYIIITDWWELLING ❑ ADDITION D / DECK❑ GARAGE/ACCESSORY STRUCTURE ❑ Sl <br /> BUNKHOUSE ❑ 59.692(1V)GAZEBO 0 STAIRS FILLING/GRADING❑ CAMPING UNIT❑ <br /> r <br /> COMMERCIAL BUILDING❑ COMMERCIAL ADDITION ❑ COMMERCIAL ACCESSORY STRUCTURE ❑ <br /> STRUCTURE/ADDITION USE: 54q I V '4, L-�. I.Uct(� d Sc <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) p <br /> BUILDING CONTRACTOR: -F m <br /> O 3 <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 V2 X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS C 0 <br /> WILL BE RETURNED. <br /> n <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) M rs <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. O <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW <br /> BUILDINGS/STRUCTURES (NB), INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, B 3 <br /> AND INDICATE NORTH (N). N o <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES,(B) BUILDING(S) <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENTS)TO THE ORDINARY HIGH WATER MARK w O <br /> (OHWM) OF LAKE,STREAM OR RIVER AND WETLAND AREAS,AND(D) LOT DIMENSIONS. O QJ <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK (ST)AND DRAINFIELD(DF),AND ALL DISTANCES q p() <br /> TO BUILDINGS, ROADS,LAKE, LOT LINES. w <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE I o Z <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN i 1 <br /> NEEDED. — y CA c, <br /> r n <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: r, a <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS.OF PERMIT. tt Z O <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. O <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS,ETC.,ALLOWED WITHIN THE REQUIRED WATER r ,! <br /> SETBACK AREA. V <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> 7. T E e o o $ <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of my <br /> knowledge and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all <br /> Information contained In this application(including any accompanying sdwdule)and I further declare that I recognize that this " 5.D 9 Y <br /> Information I am providing will be relied upon by the County of Burnett Wisconsin In determining whether to Issue a permit. I „ g w v rd <br /> further accept all liability that maybe a result of the County of Burnett relying on this Information I am providing in this ^ n i; rn u c^,'", 'V <br /> application. I agree to permit county officials charged with administrating county ordinances or other authorized person to have <br /> access to the above-described premises at any reasonable time for the purpose of inspection. ° R 65 in p A <br /> pm ',8p 008y <br /> OWNER'S SIGNATURE (date) e y Gbh• m(] W? Z <br /> n r5.5 <br /> ZONING ADMINISTRATOR y �^ : °IA <br /> f11: c: b � <br /> O: b : <br /> TOWNSHIP P ITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE �'` " »' »" <br /> �u8o 0 <br />